*Purpose: The transition of healthcare for young adults with kidney transplants from pediatric to adult care settings is an area of need, hitherto under-recognized in adult care centers. The outcomes of pediatric patients transitioned to adult care have not been studied rigorously and may help identify areas for intervention.

*Methods: We performed a retrospective study to evaluate the outcomes of 29 kidney transplant patients who were transitioned from Children’s of Alabama to University of Alabama at Birmingham between 1/1/2017 and 9/30/2020. Data are presented as medians and interquartile ranges where appropriate. Fisher’s exact test was used to compare the difference pre and post transition. Statistical analyses were performed using JMP (Cary, NC).

*Results: Out of the 29 patients, 61.1% were male, 45% were African American and 40% were White. Median age at transplant and at transition were 16.2 years (IQR 13.9-17, range 9-18.4). and 19.9 years (IQR 19.6-20.7, range 18.5-21.9) respectively and median age at last follow up was 21 years (IQR 20-22). Median time from transplant to transition was 4.3 years (IQR 2.5-5.0). Median creatinine and proteinuria at transition was 1.3 mg/dl (IQR 1.1-1.9) and 0.2 g/g (0.12-0.82) respectively. At the time of transition, ten patients (34%) had a history of rejection, 6 (21%) had a history of a positive donor-specific antibody (DSA). Nearly all patients received maintenance immunosuppression consisting of tacrolimus (93%), mycophenolate mofetil (86%) and prednisone (93%). Within 2 years following transition, 6 (20%) developed de novo DSA , 4 (14%) developed acute rejection and 4 (14%) developed graft failure (3 had acute and 1 had chronic rejection). All 4 graft losses occurred within 1 year of transition and of the 4, 3 had a pre-transition history of acute rejection and/or DSA. However DSA and rejection before transition and de-novo DSA post-transition were not predictive of graft failure within 2 years of transfer (p= 0.24 and 0.17 respectively). Pre-transition suspected non-compliance was strongly associated with rejection and DSA prior to transition (p <0.001 and p= 0.0011) but not with graft failure or de-novo DSAs post-transition (p=0.076 and p= 0.118).

*Conclusions: A significant number of patients transitioning to adult care already have a history of organ rejection and DSA. At time of transition patients had minimal proteinuria and good graft function. In a 2 year period following transfer of care, graft loss rate was low. Prior rejection, DSA and non-compliance did not impact graft loss in the early post-transition period. Additional data is needed to verify this finding and to identify areas of intervention that may improve outcomes following pediatric to adult transition of care at our center.

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